Names and pronunciation
(pram′lin-tide) SymlinPen
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Drug reference
(pram′lin-tide) SymlinPen
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Func. class.: Antidiabetic
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Chem. class.: Synthetic human amylin analog
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ACTION: Modulates and slows stomach emptying, prevents postprandial rise in plasma glucagon, decreases appetite, leads to decreased caloric intake and weight loss
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USES: As an adjunct prandial to insulin therapy for uncontrolled type 1 or type 2 diabetes
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CONTRAINDICATIONS: Hyper sensitivity to this product or cresol; gastroparesis
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Black Box Warning: Hypoglycemia unawareness Precautions: Pregnancy, breastfeeding, osteoporosis, thyroid disease, trauma, vomiting, renal failure, fever, diarrhea Black Box Warning: Fasting blood glu- cose, 2 hr postprandial (80-150 mg/dL, normal fasting level; 70-130 mg/dL, nor- mal 2 hr level); A1c may also be drawn to identify treatment effectiveness; also monitor weight, appetite • Hypoglycemic reaction: sweating; weak- ness; dizziness; chills; confusion; headache; nausea; rapid, weak pulse; fatigue; tachy- cardia; memory lapses; slurred speech; staggering gait; anxiety; tremors; hunger • Hyperglycemia: acetone breath; poly- uria; fatigue; polydipsia; flushed, dry skin; lethargy • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk, usually insu- lin is used in pregnancy; avoid breast- feeding Black Box Warning: To carry a glucose source (candy or lump sugar, glucose tabs) to treat hypoglycemia • About the symptoms of ketoacidosis: nausea; thirst; polyuria; dry mouth; de- creased B/P; dry, flushed skin; acetone breath; drowsiness; Kussmaul respirations • That a plan is necessary for diet, exer- cise; that all food on diet should be eaten; that exercise routine should not vary • About blood glucose testing; how to determine glucose level • To avoid OTC products, alcohol unless directed by prescriber • Not to operate machinery or drive until effect is known • About how to use pen
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SIDE EFFECTS CNS: Headache, fatigue, dizziness, confusion EENT: Blurred vision GI: Nausea, vomiting, anorexia, abdominal pain INTEG: Inj-site reactions, diaphoresis META: Hypoglycemia MS: Arthralgia RESP: Cough, pharyngitis SYST: Systemic allergy
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INTERACTIONS • Do not use with erythromycin, metoclo- pramide Increase: effect of acetaminophen Increase: pramlintide action—antimus- α-glucosidase carinics, inhibitors, diphenoxylate, loperamide, octreotide, opiate agonist, tricyclics Increase: hypoglycemia—ACE inhibi- tors, disopyramide, anabolic steroids, androgens, fibric acid derivatives, alco- hol, corticosteroids, insulin Increase: hyperglycemia—phenothiazines Decrease: hypoglycemia—niacin, dex- trothyroxine, thiazide diuretics, triamterene, estrogens, progestins, oral contraceptives, MAOIs
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TREATMENT OF OVERDOSE: Glucose 25 g IV or 50 mL dextrose 50% sol or 1 mg glucagon SUBCUT See Appendix B
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DOSAGE AND ROUTES Type 1 diabetes • Adult: SUBCUT 15 mcg before each meal (≥30 g carbohydrate), titrate up in 15-mcg increments to target dose of 60 mcg/dose; each dose titration should oc- cur after no nausea for 3 days Type 2 diabetes • Adult: SUBCUT 60 mcg before each meal carbohydrate, titrate up to 120 mcg; SUBCUT with each meal after no nausea for 3-7 days
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Available forms: PEN 60, 120 (1000 mcg/mL solution for injection)
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Administer: • Store at room temperature for ≤30 days; keep away from heat and sunlight; refrigerate all other supply • Premeal insulin should be decreased by 50% when starting and adjusted to thera- peutic dose to prevent hypoglycemia SUBCUT route • Rotate injection sites, allow solution to warm to room temperature before use • Take immediately before mealtime or if 30 g of carbohydrates will be consumed • Do not use if a meal is skipped • Do not use if discolored; do not give in arm; absorption is variable
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Assess:
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Evaluate: • Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait; improving blood glucose, A1c
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That product does not cure diabetes but rather controls symptoms • To carry emergency ID as diabetic • To recognize hypoglycemia reaction: headache, fatigue, weakness, fast pulse • About the dosage, route, mixing instruc- tions, diet restrictions, disease process
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PHARMACOKINETICS Bioavailability 30%-40%, not extensively bound to blood cells or albumin, 40% bound in plasma, half-life 48 min, metabolized by kidneys, peak 20 min, duration 3 hr
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• Adult: SUBCUT 15 mcg before each meal (≥30 g carbohydrate), titrate up in 15-mcg increments to target dose of 60 mcg/dose; each dose titration should oc- cur after no nausea for 3 days Type 2 diabetes
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• Adult: SUBCUT 60 mcg before each meal carbohydrate, titrate up to 120 mcg; SUBCUT with each meal after no nausea for 3-7 days
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